Role of Intraoperative Ropivacaine in Post‐tonsillectomy Pain Control: Randomized Control Trial Using a Paired Design

Objectives:1) Evaluate the efficacy of ropivacaine in post‐tonsillectomy pain management in adults using a paired design. 2) Evaluate the timing of intraoperative ropivacaine administration in post‐tonsillectomy pain control.Methods:A prospective double‐blinded randomized control trial with a paired design was performed on 25 consecutive adults undergoing a tonsillectomy. One side was injected with saline and the other side with ropivacaine. Patients were also pre‐randomized into those receiving injections immediately before or after the tonsillectomy. Laterality of the injection was alternated and all surgery performed by the senior author. Patient responses were obtained via telephone interview and written questionnaire.Results:3/25 patients were excluded from the study. 16/22 patients had pain lateralize to one side during recovery. There was no statistically significant difference in pain control between ropivacaine and normal saline. Local anesthetic decreased pain in 7/22 patients while more pain was experienced on the side with local anesthetic in 9/22 patients. 6/22 patients had no difference in pain. The time to equalization of pain based on laterality was 8.8 and 6.8 days, respectively, in the pre‐ and post‐tonsillectomy group.Conclusions:Multiple studies have examined the role of local anesthetic in controlling post‐tonsillectomy pain with equivocal results. This is the first study examining the role of local anesthetic in tonsillectomies using a paired design. Administration of ropivacaine does not affect post‐tonsillectomy pain. Moreover, timing of injection does not have an effect on postoperative pain. We recommend against the use of intraoperative ropivacaine for pain control in patients undergoing tonsillectomy.